Dr. Bowers’ Office Hours: Michael Brantley

On Tuesday, August 8th in an inter league matchup with the Colorado Rockies, Michael Brantley stepped awkwardly in left field, before being removed from the game. It was later revealed, postgame, Brantley had sustained a right ankle sprain and was subsequently placed on the 10-day disabled list. Erik Gonzalez was recalled from AAA Columbus in a corresponding move to fill Brantley’s spot on the 25-man roster.

What is it?The ankle is made up of three primary joints, the talocrural joint, subtalar joint and the distal tibiofibular joint. The talocrural joint is considered to be the true “ankle joint” with the subtalar and distal tibiofibular joints providing other functions of the foot/ankle. The ankle is stabilized via static and dynamic restraint systems, these systems are ligaments and muscles respectively. In the case of an ankle sprain, the aforementioned restraint systems become compromised. Simply put, a sprain is the over stretching of ligaments which support a joint.

Ligaments that have been over stretched are unable to provide adequate stability to the joint which they support and inhibit the ability of the joint to function properly. Sprains are graded based on severity, with grade one sprains being the least severe and grade three sprains being the most severe. Grade one sprains involve slight over stretching of ligaments, grade two involve partial tears of the ligaments and grade three, being the worst, involve complete tearing of the ligaments. The terms mild, moderate and severe can be assigned to grade one, grade two and grade three injuries respectively. In the case of ankle sprains, “inversion” sprains are the most common and involve the “rolling” of the ankle inward. Symptoms of ankle sprains include swelling, discoloration (bruising), tenderness to touch and instability.

How is it fixed? Management of an ankle sprain is initiated with a period of utilization of the acronym RICE, which stands for rest, ice, compression and elevation. Rest from physical activity is important in order to minimize further aggravation of the ankle, ice is utilized in order to reduce swelling and reduce pain and compression and elevation also assist in the reduction of swelling.

Following a period of RICE, efforts will be made by the rehabilitation team to maintain range of motion and strength of the ankle. Maintenance of range of motion and strength of the ankle is important in order to improve functional mobility for the individual when it is time to return to sport. Sprained ankles have a tendency to get stiff and significant impact an individuals ability to function as they normally would.

Rehab is progressed to sport specific activities once the individual demonstrates reduction in pain and adequate strength and range of motion. Sport specific activities include running, cutting, jumping and swinging a bat among other things. Medical team members will specifically look at a player’s ability to perform these tasks with appropriate strength and range of motion, as well as without pain. Clearance to return to live game action is granted once the individual is able to run, field, throw and hit without exacerbation of symptoms. In more severe ankle sprains, such as a grade three injury, surgery may be indicated.

My take. This is the second time Brantley has dealt with a right ankle injury this season; he sprained the same ankle in May and spent a short stint on the disabled list as well. More often than not, the first ankle sprain is usually the worst, with that being said, hopefully, his most recent sprain isn’t quite as bad. The Indians indicated his sprain was mild in nature, which is the least severe on the severity scale. I expect the team to take their time with their starting left fielder as they prepare for the stretch and playoff runs. Overall, low level of concern going forward, so long as the team is not withholding any additional information.

I will continue to monitor the status of Michael Brantley as he progresses through the rehab process and will provide the most up to date injury analysis and breakdown as new information becomes available.

Brandon Bowers, PT, DPT, is a graduate of the University of Toledo, Doctor of Physical Therapy Program and currently practices in Columbus, Ohio.He is an avid Cleveland sports fan and has experience rehabbing athletes of all levels and from a variety of sports.Follow Brandon on Twitter for more Cleveland Indians injury insight and analysis:@blbowers12

The information provided is the professional opinion of Brandon Bowers, PT, DPT and is based on his clinical experience and the most current clinical evidence available.This information should not be interpreted as or substituted for medical advice for a specific condition or diagnosis.